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F. Gamal. Thomas Jefferson University.

This power in controlling after-pains suggests that it will prove valuable in congestion and neuralgia of the womb viagra soft 50mg line erectile dysfunction unable to ejaculate. In large doses it is a violent purgative generic viagra soft 50mg on line erectile dysfunction doctors in richmond va, and may produce inflammation of the bowels. It causes tormina and tenesmus, and seems to extend its influence to all the abdominal viscera, the urinary apparatus included. Its action is attended with unpleasant sensations in the head, and some times it produces severe headache. One ounce of the bark was boiled in a pint and a half of water to one pint, and the whole taken in the course of a day. A tincture may be prepared in the usual way from the bark, and used in doses of from one to thirty drops, as a sedative, diaphoretic and antiperiodic, in the treatment of malarial and other fevers. Take of the recent nuts, fully ripened, four ounces; bruise them thoroughly, and cover with alcohol 76 one pint; let it stand for two weeks; strain and filter. Of this tincture add from one to two drachms to four ounces of water - the dose being one teaspoonful. The buckeye has been used to but a limited extent in medicine, yet its activity is such (as a poison), that it will probably prove very valuable when thoroughly studied. In my boyhood, I well remember persons carrying “buckeyes” in their pockets as a sovereign cure for “piles,” and at a later period as a remedy for rheumatism. It has been used in the treatment of hemorrhoids with much success, and I am satisfied that in some forms of the disease it is the most certain remedy we possess. I have also given it in a few cases of diseased uterus with good results - cases in which the entire organ was enlarged, the cervix tumid, with to frequent recurrence of the menstrual flow. The marked influence of the Æsculus on the nervous system would suggest a line of experiment likely to lead to the development of valuable properties. It has already been employed as a stimulant to the nervous system in some cases of paralysis. We may reason in this way: a remedy that cures hemorrhoids must exert a powerful influence upon the circulation; whilst its poisonous action, often witnessed - vertigo, diminished sight, wry neck, fixed eyes, paralysis, convulsions, etc. The bark of this variety has been employed to a limited extent as a tonic, and possesses feeble antiperiodic powers. Quinine being employed to break the chill, this agent was sufficient to prevent its recurrence. The pulverized kernel has been used as a sternutatory for the relief of headache and facial neuralgia. The nuts were also thought to possess some special influence over hemorrhoids and rheumatism. This probably will be its best field of action, standing midway between Belladonna on the one hand and Nux Vomica on the other. It exerts the same influence upon the circulation as the Æsculus Glabra, and has been successfully employed in the treatment of hemorrhoids. It will doubtless be found to improve the circulation generally, and may be employed whenever there is want of power in the heart, capillary stasis, or tendency to congestion. It may be recommended in active delirium, when patients become excited from slight causes, and are liable to transports of rage. They absorb a great amount of oxygen with evolution of hydrogen and carbonic acid gas, and contain considerable proportions of nitrogen. Those species formerly included in Boletus, and whose hymenium is composed of pores, now form the genus Polyporus. The Polyporus Officinalis (Boletus Laricis), known by the name of White Agaric, Purging Agaric, etc. It is in masses, varying from the size of an ordinary apple to that of a large nutmeg-melon; its shape somewhat resembles a horse’s hoof; it is reddish gray or yellow externally, whitish internally, and of a spongy, friable consistence; hymenium concrete; substance of the pileus consisting of subrotund pores, with their simple dissepiments; pileus corky-fleshy, ungulate, zoned, smooth; pores yellowish; it has a feeble odor, and a bitter, acid, somewhat sweetish taste. Braconnot found in it 72 parts resinous matter, 2 bitter extractive, 26 of a nutritious animalized principle, which he termed fungin. It is collected in August and September, deprived of its outer covering, and then dried and placed in the sun. Polyporus (Boletus) Ignarius, Agaric of the Oak, is a fungus found on the oak, cherry, willow, plum, and other trees; when young it is soft, but gradually becomes hard and woody. In shape it somewhat resembles the preceding; its upper smooth surface is marked with dark circular ridges, and its under is very porous, and of a yellowish-white color It is tasteless and inodorous. Ignarius, when cut in slices, beaten, soaked in a solution of nitre, and dried, forms an inflammable substance, known as Spunk, Amadou, or German Tinder. The Polyporus Pinicola grows upon the pine, birch, tamarac, fir, and similar trees; with absolute alcohol the fresh fungus forms a dark-red, intensely bitter tincture. It has a bitter taste, is soluble in alcohol and oil of turpentine, forms a paste with boiling water, and has the formula C14H12O4 Properties and Uses. In doses of from three to ten grains, gradually increasing to sixty grains, in the course of the twenty-four hours, it has been found efficacious in arresting the nocturnal perspiration of consumptives. Externally, it has been used, together with the Agaric of the Oak, as a styptic, and said to restrain not only venous but arterial hemorrhages, without the use of ligatures. It does not appear, however, to possess any real styptic power, or to act otherwise than dry lint, sponge, or other soft applications. Pinicola, in doses of from three to four grains of the powder, repeated every three or four hours, or of the concentrated tincture in doses of five drops, have both been found valuable in the cure of obstinate and long standing intermittents, and other diseases common to malarial districts; as obstinate bilious remittent fever, chronic diarrhœa, chronic dysentery, periodical neuralgia, nervous headache, ague cake, and increased flow of urine. They have likewise proved useful in long standing jaundice, and in the chills and fever common among consumptive patients. The tincture of Boletus exerts a marked influence upon the spinal and sympathetic nervous system, in certain cases of disease. It has been successfully employed in the treatment of epilepsy and chorea, and to check the rapid pulse with hectic fever and night sweats in phthisis. It has also been recommended in insanity where there is a feeble cerebral circulation and imperfect nutrition. Pressing pain in the occiput and an inclination to fall backwards is also a very good indication. The most marked evidences of improvement were observable at every successive visit. From observing the effects of the Maguey in the cases which have occurred in this command, I am compelled to place it far above that remedy which, till now has stood above every other - lime juice. The manner in which I use it is as follows: The leaves are cut off close to the root. They are placed in hot ashes until thoroughly cooked, when they are removed, and the juice expressed. Agrimonia exerts a slight stimulant influence upon all the vegetative processes, and under its use we find an improvement of appetite, digestion and nutrition. It exerts a specific influence upon mucous membranes, checking profuse secretion, and giving tone. But it is especially useful in chronic catarrhal disease of the kidneys and bladder, and will frequently prove curative. It gives tone and strength to these organs, and may well replace the more common tonic diuretics in many cases.

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Body fluids/Apply knowledge to identify sources of Glucose can be consumed by glycolysis or oxidation error/Urine/Specimen collection and handling/2 by cells discount viagra soft online erectile dysfunction dr mercola. C The D-xylose absorption test is used to distinguish D-xylose absorption test on an adult patient? D-xylose is absorbed without the boric acid aid of pancreatic enzymes order 50mg viagra soft with mastercard xyzal erectile dysfunction, and is not metabolized C. Random urine preserved with formalin by a plasma level < 25 mg/dL and urine excretion Body fluids/Apply principles of basic laboratory of < 4g/5hours) points to malabsorption syndrome. Urine in the bladder is voided and discarded at must be emptied of urine at the start of the test the start of the test and discarded. At 24 hours, any urine in the bladder is voided conclusion of the test and the urine added to the and added to the collection collection. Associated with diabetes mellitus causes retention of H O within the tubule, 2 Body fluids/Correlate clinical and laboratory resulting in dehydration and polyuria rather data/Urine volume/2 than oliguria. Glucose Body fluids/Evaluate laboratory data to determine possible inconsistent results/Specific gravity/2 6. Water and salt are retained, disease states/Specific gravity/2 and the urine:plasma osmolar ratio (U:P) exceeds 2:1. Refractometry should be performed before the Cells and undissolved solutes refract light and will urine is centrifuged cause a falsely high specific gravity reading by Body fluids/Apply knowledge to identify sources of refractometry if urine is not centrifuged. Colorimetric error/Specific gravity/2 specific gravity tests are less sensitive to nonionized compounds such as urea and glucose, and are 22. Ionic strength alters the pKa of a polyelectrolyte gravity readings are determined by a pH change B. Sodium and other cations are chelated by a on the test pad and are approximately 0. Ionized solutes catalyze oxidation of an azo dye in proportion to the ionic strength of urine. This Body fluids/Apply principles of basic laboratory causes the pH indicator, bromthymol blue, to react procedures/Specific gravity/1 as if it were in a more acidic solution. Contamination should be suspected if urine pH Extended storage may result in loss of volatile acids, is less than 4. Body fluids/Correlate clinical and laboratory data/ Urine pH/2 334 Chapter 6 | Urinalysis and Body Fluids 24. Variable, depending upon diet ions are not secreted when bicarbonate ions are not reabsorbed. When Body fluids/Apply knowledge of fundamental biological fluid intake is excessive, up to 2. D Urine pH is determined by diet, acid–base balance, characteristics/Urine/1 water balance, and renal function. A patient with partially compensated respiratory compensated respiratory alkalosis, the kidneys alkalosis would have a urine pH of: reabsorb less bicarbonate, which results in lower net A. B In addition to highly buffered alkaline urine, a Body fluids/Correlate clinical and laboratory data/ false-positive dry reagent test may be caused by Urine pH/2 quaternary ammonium compounds, which increase 28. Because the dry reagent strip tests are false-positive dry reagent strip test for urinary insensitive to globulins, a false negative is likely in protein? Highly buffered alkaline urine strip protein tests but is common for turbidimetric C. B Turbidimetric assays are used to test urine suspected error/Urinary protein/2 of giving a false-positive dry reagent strip test for albumin because the urine is highly alkaline (pH ≥ 8. Highly buffered alkaline urine of globulins because dry reagent strip tests are far less B. Iodinated dyes, penicillin, salicylate, and Body fluids/Apply knowledge to identify sources of tolbutamide may result in false positives. Trace error/Urinary protein/2 turbidity is difficult to determine when urine is cloudy due to bacteriuria, mucus, or crystals. After catheterization of the urinary tract This increases the refractive index of urine, causing B. Osmolality is the most specific measure of total solute Body fluids/Evaluate data to determine possible concentration because it is affected only by the inconsistent results/Specific gravity/2 number of dissolved solutes. D Dry reagent strip tests using tetrabromophenol blue false-negative dry reagent strip test for or tetrachlorophenol tetrabromosulfophthalein are proteinuria? Bence–Jones protein tolbutamide, salicylates, and x-ray contrast dyes Body fluids/Apply knowledge to identify sources of containing iodine. Amorphous phosphates may error/Urinary protein/1 precipitate in refrigerated urine, making 32. Daily loss of protein in urine normally does not interpretation of turbidimetric tests difficult. Which of the following is least likely to cause a occur in the absence of renal disease. Penicillin or sulfa antibiotics taking megadoses of ascorbic acid (vitamin C) may D. Ascorbic acid show negative interference with tests for glucose, Body fluids/Apply knowledge to identify sources of blood, bilirubin, and nitrite. Ascorbate does not cause error/Urinary protein/2 either a false-negative or positive reaction for protein. Testing may detect early renal involvement in sensitivity (detection limit below 15 mg/dL), and is diabetes mellitus recommended for persons who are at risk for B. Microalbuminuria refers to a specific subfraction chronic renal disease, especially persons with of albumin found only in persons with diabetic diabetes mellitus. In diabetes, an early sign of renal nephropathy involvement is an increased rate of albumin excretion C. A positive test result indicates the presence of in the range of 20–200 μg/mL or in excess of orthostatic albuminuria 30 mg albumin per gram creatinine. Testing should be part of the routine urinalysis range are significant in the at-risk population even though the dry reagent strip test for protein may be Body fluids/Correlate clinical and laboratory negative. Consequently, dry reagent strip tests for data/Urinary protein/2 microalbuminuria are too sensitive for use in routine urinalysis, but are useful in screening persons with diabetes and hypertension for increased urinary albumin excretion. Dry reagent strip tests for microalbuminuria that Answers to Questions 35–39 compare albumin to creatinine determine the creatinine concentration based upon which 35. Formation of a Cu+2-creatinine complex tetramethylbenzidine, and diisopropyl benzene B. Reaction of creatinine with alkaline sodium oxidation of a benzidine derivative by an alcoholic picrate peroxide, forming a blue color on the test pad. Change in pH as creatinine is converted to intensity is proportional to creatinine concentration. Positive interference Body fluids/Apply principles of special laboratory occurs from hemoglobin and some drugs (e. Which of the following conditions is least likely concentration is determined by the protein error to be detected by dry reagent strip tests for of indicator effect using a dye with increased proteinuria? Renal tubular proteinuria orthostatic albuminuria and renal diseases, with Body fluids/Apply principles of basic laboratory the exception of tubular proteinuria.

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And when I order viagra soft with a visa impotence versus erectile dysfunction, when I uh buy viagra soft 100mg fast delivery erectile dysfunction generics, I was functioning but when I was shaving one day, I was shaving and I looked and I saw it. Bill indicates that he responded positively to Modacate, a typical antipsychotic medication, in the past, by positioning himself as “stabilized” and “functioning” and recalling that he requested psychotherapy as an adjunct to effective medical treatment. Despite this positive response, Bill states that he was influenced by his doctor to discontinue taking Modacate 172 due to the risk of tardive dyskinesia. Specifically, Bill details that his doctor “sowed the seed” that he could be experiencing tardive dyskinesia, following which, his awareness of side effects linked to the condition was raised and he noticed a facial cramp while shaving. Bill indicates that he did not experience side effects prior to the discussion with his doctor (“And I thought, I’m not really”), highlighting how the mere threat of side effects (and not necessarily the experience of any) can influence a consumer’s experiences of taking medication and, thereby, their adherence choices. Some consumers, like Margaret below, are prescribed other medications to address the side effects of antipsychotic medication, which could assist with adherence: Margaret, 04/02/2009 M: When I was first diagnosed I was at [mental health facility] and I had a very, very bad reaction. And then the doctor came and uh, um, he uh gave me an injection and all of a sudden I went, you know, it relaxed me, and then after that I was put on benztropine. Margaret recalls experiencing a “very bad reaction” to medication whilst in a mental health facility. She indicates that she experienced 173 muscular side effects (“my neck twisted round”) which were particularly distressing for her (“I looked in the mirror and I thought, oh god, nooo”). Margaret’s extract highlights how prescriber intervention can assist consumers to manage side effects. In this instance, her doctor administered an injection, which alleviated the side effects (“it relaxed me”). Rather than changing medications she recalls that from thereon, she was prescribed benztropine to manage her side effects. It could be argued that the doctor’s intervention for Margaret may have prevented non-adherence. In the following extract, Anna talks about how poly-pharmacy and the side effects of this influenced her to become non-adherent: Anna, 18/02/2009 L: Yep. A: Yeah they put me on another, they put me on this cocktail of drugs and when I came out. A: Because I didn’t like what it was doing to me and then I lost the plot again (laughing). She directly represents the sedating side effects and the sheer “amount” of medication that she was prescribed as influences on her decision to discontinue medication (“because I didn’t like what it was doing to me”). It is uncertain whether Anna associates the amount of medication with more side effects, or whether she perceived the regimen as too complicated to effectively be adherent to. On a side note, Anna initially states that she stopped taking the prescribed regimen and reverted to taking “what [she] was on before”, challenging definitions of adherence given that she may have been following a previous prescription. In the next extract, also from Anna’s interview, she negatively evaluates the practice of consumers being medicated large amounts and/or high dosages of medication upon admission to hospital: Anna, 18/02/2009 L: So what happens when you go to hospital? L: No, it’s not because you’re not, I mean, it’s like you’re not really being treated with respect. Anna challenges the practice of over-medicating consumers upon admission to hospital, as have been her experiences (“It’s not right”). According to Anna, hospital staff “bomb” consumers with medication to counter any resistance (“and they won’t give you a hassle”) or to manage difficult behaviours (“It’s like you’re too hard to deal with”). She recalls experiencing significant side effects as a result of being over-medicated, including cognitive difficulties (“you can’t think”) and describes herself as “just existing” and “not functioning”. Whilst Anna does not link these experiences to non-adherence in this extract, it could contextualise her reported non-adherence to a complex medication regimen as acknowledged in the previous extract. In the following extract, Travis challenges whether antipsychotic medication should be the first-line of treatment for people who experience psychoses, on the grounds that it causes side effects: Travis, 19/02/2009 T: If they’ve got a permanent illness and they need them [medication], then that’s it, you know, but if it can be calmed down and they can push through it without them, they’ll never have to worry about that, you know, but it’s never that easy, you know. But my view is it’s 176 a good thing but it would be lovely for newer tablets to come out with less side effects. T: Yeah and you know, it makes very motivated people just not want to get off the couch. The significance of side effects to consumers is highlighted above, through Travis’s representation of medication adherence as essential only for consumers who are chronically ill and are dependent on or “need” medication. He acknowledges the struggle associated with persevering with illness symptoms in the absence of medication by pointing out that consumers will have to “push through it” but constructs life “without” medication as a better alternative to medication adherence in unspecified circumstances, potentially for first episode consumers, for example, for whom the likelihood of relapse is uncertain. Despite recognizing the benefits of medication adherence for consumers (“it is a good thing”), Travis implies that the efficacy of antipsychotic medication is somewhat offset by associated side effects (“but it would be lovely for newer tablets to come out with less side effects”). Travis specifically links medication adherence to the side effects of decreased motivation, increased appetite and weight gain, using pre and post-medication adherence comparisons to emphasise the drastic impact of side effects. Travis’s stance in relation to medication adherence despite attributing medication adherence to saving his life highlights the significance of side effects to consumers. Research consistently indicates that the efficacy (or perceived efficacy) of medication in treating illness symptoms exerts a significant influence on adherence (i. The main utility of medication was seen as its ability to act directly on symptoms by stopping them or reducing them to make them more manageable. The degree to which consumers’ past and present medications treated illness symptoms varied. There was also inter-consumer variability in terms of responses to the same medications. The impact of medication on symptoms was emphasised through constructions of adherence as intrinsically linked to “sanity” or “normality”, which were contrasted with constructions of non-adherence as related to “insanity” or “abnormality”. The following extracts, thus, also tend to emphasise how mental illness can detract from consumers’ lives and how medication addresses detractions. It is noteworthy that like the “Reflection on Experiences” code, this code also emphasises that experiences with medications and adherence are interlinked. In the following extracts, direct correlations between adherence and sanity, and non-adherence and insanity, are made: 178 Ryan, 26/09/2008 R: Uh, um yeah, the difference between being sane and not being sane, so that’s how I’d encourage other people. Because like, being, being bad and then being good is two different sides of the fences, ya know? G: Because like, with the medication, it impacts a lot ‘cause we’re dependent, we’re not dependent on it, but… it helps keep us sane sort of thing, ya know, it helps. In the context of being asked how adherence could be encouraged amongst consumers, Ruth emphasises the effectiveness of medication in treating symptoms through her construction of medication adherence as “the difference” between two opposing mental states: “being sane and not being sane”. Gary also constructs medication adherence as the catalyst for a shift between contrasting mental states. He deploys a fence metaphor to illustrate how, by “over-rid[ing] the symptoms”, medication adherence is aligned with 179 “being good” and implies that non-adherence is aligned with “being bad”. Gary elaborates by attributing his maintained adherence, constructed as medication “dependence”, to the capacity of medication to “keep us sane”. Medication adherence is ascribed a significant amount of power in the above extracts, as it is essentially associated with alleviating insanity. In the following extracts, interviewees promote adherence by indicating that through its efficacy in treating symptoms, medication can normalise consumers. I’ve never been on strong medication but if I don’t take my medication it ain’t funny you know? The number one strategy what I’d say to someone with schizophrenia to take their medication is that sometimes, being out of the hospital, say for the first episode, for me, for example, um, it uh, they give you medication in tablet form like I did, but they may give you injections and sure, it may be sedating, a bit tiring and lack of energy taking some of these different medications for schizophrenia but the reality is, uh, then you 180 realise you will turn to normal because it treats that, I guess that chemical imbalance in your mind.

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After completing the exercises and looking at your thoughts in new and different ways order viagra soft now erectile dysfunction caused by ssri, take time to reflect on your new insights using the space in Worksheet 6-27 order viagra soft 100mg on line ginkgo biloba erectile dysfunction treatment. Some folks grab glasses off the nightstand, others need to get up and put in their contacts to see better. What most people don’t know is that everyone’s vision of reality is altered by special life- lenses. Life-lenses are strongly held beliefs or assumptions that you have about yourself, your relationships with others, and your world. Life-lenses powerfully influence how you respond to, interpret, and feel about events, but you may not be aware that you look through them. On the other hand, you probably know a few folks who view the world through dark, gloomy shades. Your views of people, events, and even your self-image depend upon which lenses you look through. This chapter helps you realize whether your lenses are dirty, cracked, smoky, colored, or clear. A quiz shows you which lenses you look through and how they may cause you emotional trouble, and the exercises demonstrate how to change problematic life-lenses. For example, it’s not a bad idea to assume that day follows night, taxes must be paid, food is located at grocery stores, most drivers stop at red lights, and hard work usually pays off. Think about how snarled traffic would be if no one assumed that red means stop and green means go. Or just consider how much time you’d waste if you searched for food in department stores, schools, and libraries rather than assuming that you’d find it in grocery stores. These assumptions or beliefs color the way you feel about yourself and the things that happen to you. Or perhaps you have a vulnerable life-lens and thus assume that the world is a dan- gerous place. As we explore assumptions (that is, life-lenses) such as these, you can see that they form the foundation of your most distressing emotions, such as depression, anxiety, worry, irritability, apprehension, and even anger. These themes directly influ- ence the kinds of thoughts you have and, in turn, how you feel about what happens to you. Although Susan and Diane are both well qualified, a nurse from another hospital gets the job. Susan reacts with anger and comments, “I deserved that job; the administration had no right to give that job away. She feels gloomy and says, “I’m sure they made the right deci- sion picking someone else. She believes that she always deserves the best; Susan feels that the world owes her and that if she wants something, it should be hers. She thinks that she’s not good enough and that others have more skill and talent than she does. Diane assumes that she couldn’t do the job even though her supervisor told her she has the appropriate ability and background. Susan’s entitled life-lens makes her prone to tension and anger when her needs aren’t met. Diane’s inadequacy life-lens steers her in the direction of depression when her adequacy is called into question. Susan and Diane apply their respective life-lenses to many different events in their lives. For example, when they’re both caught in an unexpected traffic jam, they view the event through their own life-lenses and thus experience different thoughts and feelings. Susan’s entitled life-lens leads her to feel rage and have thoughts like, “No one in this town knows how to drive. After all, changing the way you feel starts with identifying your problematic life-lenses. If you aren’t aware of your own life-lenses, you’re powerless to do anything about them. The questionnaire in Worksheet 7-1 is designed to clarify which life-lenses may be causing you trouble. After you identify them, we tell you a little more about how they work, where they come from, and most importantly, what you can do about them. Before you start mark- ing the life-lenses in the worksheet that apply to you, consider the following tips: Answer as honestly as possible. Sometimes, people respond how they think they “should” answer rather than responding with honest self-appraisals. Take your time to reflect on various events and situations that have happened to you that are relevant to each lens. For example, in answering questions about abandonment-fearful versus intimacy-avoidant, ponder the relationships you’ve had and how you feel and react to those close to you. Chapter 7: Correcting Your Life-Lenses: A New Vision 101 Base your answer on how you feel and react in situations that relate to each lens. For example, if you frequently feel inadequate but know in your head that you’re actu- ally not inadequate, answer on the basis of how you feel when your adequacy comes into question, such as when you’re asked to make a speech. For example, if you’re a perfectionist, you may also quite often feel inadequate when you make a mistake. Or if you normally feel unworthy and undeserving, you may find yourself feeling quite angry and entitled on occasions when your needs unexpect- edly go unmet. People often flip between opposite lenses, so don’t worry if you seem a little inconsistent. If you see parts of the description that apply and others that don’t, underline the parts that fit and rate your- self on those parts in terms of how often they apply to you. I’d just as soon lost without someone in my life, and I worry stay away from any emotional involvement; I don’t about losing those I care about. I don’t there’s a right way and a wrong way to do things, like taking on things I’ve never done before if and I want to do things the right way. I worry about whether I’ve done the conscience stand in my way if I want something wrong thing. I never let It’s hard for me to set limits with people, so I anyone see how I feel. Any life-lens that you rate as 3 or above probably gives you trouble now and then. If you dis- cover that you have many life-lenses that you rate as 3 or above, don’t worry. Take a few minutes now to reflect on the results of your Problematic Life-Lenses Questionnaire. In Worksheet 7-2, jot down thoughts about how these life-lenses may be causing you to have troubling emotions. Don’t worry if you’re not quite sure of the connec- tions; we give you more ways of seeing the lenses’ influence on your life in the next few sections of this chapter.